Legacy in the News: Birth Control Basics For Parents

Metro Parent - May 2014

If you have a new baby, birth control is probably the last thing on your mind. You’re sleep deprived, your whole body aches, and you’d rather move to a snake-infested jungle than have intimate contact with your partner. That’s exactly why you should be thinking about contraception, local experts say. While it might be difficult to imagine having close contact with anyone but your newborn for quite some time, if you don’t plan ahead, you could find yourself pregnant again before you even thought it was possible. The good news is, an increasing number of highly effective options are available these days, most with few to no side effects, including low-hormone birth control pills, smaller IUDs, and apps that help you accurately track ovulation for natural family planning. Whether you know you want more kids, aren’t quite sure, or are definitely finished building your family, there’s a contraceptive alternative that’s right for you.

TIER ONE

To begin the discussion, Dr. Paula Bednarek, co-director of Planned Parenthood Columbia Willamette, stresses the importance of effectiveness. Long-acting reversible contraceptives (LARC) are among the most effective, at about 99 percent, according to Dr. Bednarek, who is also an assistant professor of obstetrics and gynecology at Oregon Health & Science University. LARC methods include intrauterine devices (IUDs) and implants. Three different IUDs are currently available in the United States. The Merena and the Skyla (brand names) are made of plastic. Both contain a low dose of the hormone estrogen and thicken the cervical mucus, making it impenetrable to sperm. The Skyla is a smaller version of the Merena and may be more suitable for smaller women or those who haven’t given birth. The Perigard (also a brand name) is an IUD made of copper, which disrupts sperm mobility and damages sperm, preventing them from joining with an egg. The Skyla and Merena can be left in place for five years while the Perigard is good for ten years. All three IUDs must be inserted by a health care professional, and all can be removed early if a woman decides she wants to get pregnant or wants to switch to a different form of birth control.

In research studies, IUDs have the highest satisfaction rate and the highest continuation rate of all birth control methods, Dr. Bednarek says. Southeast Portland mom Rebecca Binford has used an IUD for years. “It’s great for reliability and great for spacing kids out,” says Binford, the mother of a 4-year-old. She and her husband aren’t sure if they want to have more children. Binford used an IUD before her pregnancy and got another after her son was born. In addition to the effectiveness of the device, she says she appreciates the fact that it hasn’t caused her to gain weight the way birth control pills did. A second LARC method, the hormonal implant sold under the brand names Nexplanon and Implanon, also is 99 percent effective. It consists of a match stick-sized implant containing progestin placed in a woman’s upper arm. The implant is good for three years. Because Nexplanon contains progestin only, it is safe for women to use while they are breastfeeding, Dr. Bednarek says. (Estrogen has been associated with lower milk production in lactating moms.)

The advantages of the implant are similar to those of an IUD – you don’t have to think about it every day and it’s highly effective.The implant works by suppressing ovulation. Bleeding often is lighter but may also be irregular. According to Dr. Megan Bird, medical director of Legacy Medical Group - Women’s Specialties, implants are currently the most popular birth control method among her patients. “They’re foolproof,” says Dr. Bird. “Parents love them because they don’t have to think about them. Implants can also be removed whenever a woman wants a child.” After removing an implant, the return to fertility takes a month or two.

Some couples opt for a more permanent method of birth control – sterilization. This is considered the third Tier One method, as it also has an effectiveness rate of 99 percent. For women, options include closing the fallopian tubes through tubal ligation or blocking the fallopian tubes by stimulating the growth of scar tissue. For men, it’s a vasectomy. Sterilization is meant to be permanent, though in some cases vasectomies can be reversed. Tubal ligation is usually achieved by tying and cutting the fallopian tubes, which can be done immediately postpartum or at a later date through laparoscopic surgery. The fallopian tubes also can be closed or blocked using an electric current, clips, clamps or rings. Essure is the brand name of the coils placed in the fallopian tubes to stimulate the growth of scar tissue, which then blocks the tubes. Because Essure is inserted through the vagina, it is a less expensive procedure than tubal ligation and is done in a physician’s office. Danielle Nichols chose sterilization following the birth of her third child. “I was definitely one of the absolutely done people,” says Nichols, who lives in northeast Portland. “The biggest driving factors were financial security and mental and emotional well-being. I know that I only have so much to give.” Nichols and her husband decided to divorce while she was pregnant with her third child, which may have influenced her decision, she adds. Nichols scheduled a tubal ligation 12 hours after her third child was born. She says the surgery was like a mini C-section, causing her discomfort for about a week but no terrible pain. “I remember very distinctly my own mother coming to me and asking what if I meet someone else who wants kids,” she recalls. “I told her, well, I have three good ones.”

In a vasectomy, the two vas deferens (the tubes that carry sperm) are cut, preventing sperm from entering a man’s seminal fluid. The sperm is simply reabsorbed into the man’s body. A vasectomy is a 15- to 20-minute office procedure, with a recovery time of about a week. Kelly McDonald, a northeast Portland mother of two, was off and on birth control pills for many years. After the birth of her second daughter – who was colicky and left her and her husband, Rob, sleepless for months – Rob decided two children was just the right number. “That was fine with me,” says McDonald. “He volunteered to have a vasectomy and didn’t complain at all. I was so grateful that he was willing to do the surgery. That’s a real man.” McDonald says her husband experienced a couple days of tenderness after the vasectomy, but recovered quickly. “I’ve never regretted not having another child,” she adds.

TIER TWO

Tier Two contraceptives have an effectiveness rate of 92-99 percent when used correctly. They include the Lactational Amenorrhea Method (breastfeeding), birth control pills, Depo Provera, the patch, and the ring. When breastfeeding exclusively, around the clock, most women don’t produce the hormone necessary to stimulate ovulation for the first six months after giving birth, making breastfeeding a fairly reliable form of birth control. Some women start ovulation before the end of the sixth month, however, so it’s good to resume using some form of birth control before then. Birth control pills, both the estrogen-progestin combination and the progestin-only pill, work by thickening the cervical mucus, which prevents sperm from reaching the eggs, and by preventing the eggs from leaving the ovaries. When taken every day as directed, both pills are 99 percent effective.

Side effects can include bleeding between periods, weight gain, nausea and vomiting, but these often go away after a woman has been on the pill for two or three months. Women who have had breast cancer cannot take progestin, and those who are breastfeeding cannot take the combination pill because estrogen may decrease the amount of breast milk a woman produces. Depo Provera is the brand name for the shot of progestin given in the arm every three months to prevent pregnancy. While as effective as birth control pills and safe to use during breastfeeding, it does have to be administered by a medical clinician every 12 weeks. “That’s usually the reason it fails,” says Dr. Bednarek. Dr. Bednarek avoids prescribing Depo Provera to those with a tendency toward depression, and other doctors say it can lead to marked weight gain.

The patch (brand name Ortho Evra) and the ring (brand name NuvaRing), both available by prescription, work by releasing progestin and estrogen into the body. A woman places a new patch on her body once a week for three weeks, then takes a week off, during which she usually has her period. This cycle is repeated every month. The ring is self-inserted once a month and stays in place for three weeks.

TIER THREE

Tier Three birth control includes the barrier methods – most notably the male condom, but also the female condom, the diaphragm, the cervical cap and the sponge. Effectiveness of these methods ranges from 76-88 percent. If used correctly every time a couple has intercourse, however, the effectiveness of the male condom goes up to 98 percent. Fertility awareness-based methods – also known as the rhythm method or natural family planning – also are options, though they depend on a woman carefully tracking her ovulation and refraining from intercourse on her fertile days.

According to the Planned Parenthood website, 24 out of 100 women become pregnant each year because they use fertility awareness-based methods incorrectly or inconsistently. Effectiveness goes up when these methods are used correctly and consistently. Dr. Bird says birth control methods in all categories work well as long as you actually use them. It’s important to know what will work for you without complicating your life further. “Parents need to consider what they can realistically manage,” says Dr. Bird. “We hate for birth control to be a burden.”